3701-17-60 Dietary services; supervision of special diets.

(A) Each residential care facility shall specify in its residential care facility policies and the resident agreements, required by rule 3701-17-57 of the Administrative Code, the amount and types of dietary services it provides. The facility shall elect to provide any of the following:

(1) No meals;

(2) One, two, or three daily meals;

(3) Preparation of regular and special diets other than complex therapeutic diets; one, two, or three daily meals; or

(4) Preparation and supervision of special diets. Each facility that elects to supervise special diets shall provide three daily meals and meet the requirements of this chapter of the Administrative Code for the supervision of special diets;

(5) Each residential care facility that provides meals shall include a variety of food accommodating religious restrictions and ethnic and cultural preferences of residents in accordance with the residential care facility's policy.

(B) Each residential care facility that agrees to provide three daily meals for a resident shall make available at least three nourishing, palatable, attractive and appetizing meals at regular hours. The meals shall provide the dietary referenced intake of the "Food and Nutrition Board" of the "National Academy of Science", be based on a standard meal planning guide from a diet manual published by a dietitian, approved by a dietitian, or both. There shall be at least a four-hour scheduled interval available between the mid-point of the breakfast meal and the mid-point of the noon meal and between the mid-point of the noon meal and the mid-point of the evening meal. The hours of meal service shall take into consideration residents' preferences. The facility shall make evening snacks available .

(C) Each residential care facility that agrees to provide one or two meals a day shall provide meals based on a standard meal planning guide from a diet manual published by a dietitian, approved by a dietitian, or both. Meals shall provide the dietary referenced intake of the "Food and Nutrition Board" of the "National Academy of Science," and shall follow the patterns set forth in this paragraph:

(1) The breakfast meal shall include at least:

(a) One and one-half ounce cooked, edible portion of lean meat, eggs, legumes, or other protein;

(b) One and one-half cups of fruit or vegetables;

(c) Two servings of enriched or whole grain bread or cereals;

(d) Two teaspoons of butter or margarine as appropriate; and

(e) One cup of milk or milk product.

(2) The lunch or dinner meals shall include at least:

(a) Two ounces cooked, edible portion of lean meat, eggs, legumes, or other protein;

(b) One and one-half cups of fruit or vegetables;

(c) Two servings of enriched or whole grain bread or alternate;

(d) Two teaspoons of butter or margarine as appropriate; and

(e) One cup of milk or milk product.

(3) Each meal shall include the choice of appropriate condiments, sauces and dressings.

(D) Each residential care facility that prepares special diets other than complex therapeutic diets shall:

(1) Prepare and provide the special diets in accordance with the orders of a physician or other licensed health professional acting within their scope of practice, or a dietitian; and

(2) Adjust special diet menus as ordered by the resident's attending physician or other licensed health professional acting within their scope of practice or a dietitian.

(E) Each residential care facility that provides one or more meals and that does not permit residents to have food in their resident units shall make snacks available twenty-four hours a day.

(F) Each residential care facility that does not provide any meals shall ensure that each resident unit is appropriately and safely equipped with food storage and preparation appliances which the facility maintains in safe operating condition or that each resident has access to an appropriately and safely equipped food storage and preparation area. Each residential care facility that does not provide any meals shall permit residents to store and prepare food in a safe manner in their resident units or in a resident food storage and preparation area.

(G) Each residential care facility shall have a kitchen and other food service facilities that are adequate for preparing and serving the amount and types of meals the facility agrees to provide.

(H) If applicable, the residential care facility shall have a food service operation license issued under Chapter 3701-21 of the Administrative Code.

(I) Each residential care facility that provides meals shall procure, store, prepare, distribute, and serve all food in a manner that protects it against contamination and spoilage.

(1) Each residential care facility shall assure that the kitchen and dining areas are cleaned after each meal and shall:

(a) Transport meals in a sanitary manner to prevent contamination;

(b) Provide handwashing facilities, including hot and cold water, soap and individual towels in the food preparation and service area.

(c) Provide and maintain clean and sanitary kitchen and dining areas and a clean, sanitary and adequate supply of eating and drinking utensils, pots, and pans for use in preparing, serving, and eating appetizing meals and snacks;

(d) Place food scraps and trash in garbage cans with tightfitting lids and bag liners and shall empty garbage cans daily, or more often if needed. Nondisposable containers shall be cleaned frequently enough to maintain sanitary conditions. Disposable bags of garbage may be stored outside only in a non-absorbent container with a close-fitting cover. Liquid wastes resulting from compacting shall be disposed of as sewage.

(2) Residential care facilities may provide any format of meal service, which otherwise meet the requirements of this rule, with input from residents.

(3) Residential care facilities may provide a dining environment as natural and independent as possible, comparable with eating at home, with choices from a wide variety of food items tailored to the residents' wants and needs, which otherwise meet the requirements of this rule.

(J) Each residential care facility that supervises special diets shall, at minimum:

(1) Provide dietary services in accordance with paragraph (B) of this rule;

(2) Assure that special diets are prepared and offered as ordered;

(3) Monitor and document resident acceptance of special diets;

(4) Monthly weigh and record the weights of residents on special diets:

(a) For residents on special diets other than complex therapeutic diets, notify either the dietitian or the resident's attending physician or other licensed health professional acting within their scope of practice, or both, of any unplanned significant weight changes in accordance with facility policies;

(b) For residents on complex therapeutic diets, notify the resident's attending physician or other licensed health professional acting within their scope of practice and the dietitian required by paragraph (K) of this rule of any unplanned significant weight changes in accordance with policies and procedures developed by the dietitian.

(5) Adjust special diet menus as ordered by the resident's attending physician or other licensed health professional acting within their scope of practice, or a dietitian.

(K) Each residential care facility which supervises complex therapeutic diets shall provide or arrange for a dietitian to plan, oversee, and assist in implementing dietary services that meet the residents' needs and comply with the requirements of this rule. The dietitian shall, at a minimum, consult quarterly with the food service staff. Each residential care facility shall ensure the dietitian performs the following functions for residents on complex therapeutic diets:

(1) Plan, oversee, and assist in the implementation of nutrition services that meet the needs of the residents;

(2) Evaluate the residents' acceptance of meal service and response to nutrition related interventions at least quarterly;

(3) Within one month after the facility begins supervising a new complex therapeutic diet, monitor staff that prepares or serves a new complex therapeutic diet and monitor the resident receiving a new complex therapeutic diet. The facility shall notify the dietitian upon receipt of a physician's order for a new complex therapeutic diet. For the purposes of this provision, "new complex therapeutic diet" means either a complex therapeutic diet that the residential care facility has never before supervised or a complex therapeutic diet that has been prescribed for a resident for the first time; and

(4) Oversees and assists in the training of food service staff in the preparation and serving of foods including any special dietary interventions.

(L) Each residential care facility that provides meals shall maintain at all times for residents a one-week supply of staple foods and a two-day supply of perishable foods. The amount of such supplies shall be based on the number of meals the facility, through its admission policies and resident agreements, has decided to provide daily.

(M) Each residential care facility that provides meals shall plan all menus for meals at least one week in advance. Food shall vary in texture, color and include seasonal foods. Residential care facilities shall maintain records of dated menus, including complex therapeutic diets, as served for a period of at least one year. The records shall be made available to the director upon request. The records shall indicate any substitutions made to the menus except that alternate items offered to individual residents because of food intolerances or preferences do not need to be recorded unless the resident is on a complex therapeutic diet. All foods substituted shall be of similar nutritive value.

(N) Each residential care facility that provides meals shall observe, supervise, and assist a resident in consuming meals if the resident needs observation, supervision, or assistance. The residential care facility shall ensure that food texture is appropriate to the individual needs of each resident, except that residential care facility staff shall not perform syringe feedings.

(O) Residential care facilities shall not administer parenteral nutrition. A residential care facility may administer enteral tube feedings on a part-time intermittent basis in accordance with rule 3701-17-59.1 of the Administrative Code.

(P) All residential care facilities shall provide safe drinking water which shall be accessible to residents at all times.

(Q) A hospice patient's diet shall be planned by a dietitian, the hospice program, or both, as appropriate for that individual.

Effective: 01/01/2013
R.C. 119.032 review dates: 09/25/2012 and 09/15/2017
Promulgated Under: 119.03
Statutory Authority: 3721.04
Rule Amplifies: 3721.01 , 3721.011 , 3721.07
Prior Effective Dates: 12/21/1992, 9/29/96, 6/21/97, 12/01/01, 4/01/07